In the early morning of March 3 last year, on the flyover of Castle Peak Road in Tsuen Wan, a middle-aged mother stretched out her hand and lifted her two-week-old daughter out of the railing of the overpass, apologized to her daughter and let go, then went down the bridge to check the situation and called the police. In mid-last month (June 4), the mother pleaded guilty to one count of "infanticide" in the High Court. I believe that there is no mother in the world who has gone through the hardships of being pregnant for ten months in order to become the murderer of her child, why did this mother kill the killer? After her arrest, she revealed that she felt tired and anxious because she had been caring for her daughter all night, and even had thoughts of harming herself and her children, and that she went out that day to avoid waking her sleeping husband with her daughter's crying. She tried to confide in her husband and members of the trauma society, and the response was simply to relax and stay optimistic. "Postpartum depression" is not the only explanation for the tragedy, but it is the driving force behind the tragedy and has been ignored for a long time.

Many mothers have to take care of their children alone, and there is more pressure when there is no help. (Visual China/GettyImages)

"Postpartum depression" cannot be ignored

According to the Social Welfare Department, there were 2016 cases of child attacks and deaths between 2018 and 7, of which 5 were committed by parents and 4 by mothers and were the primary caregivers of the child victims; In addition, two mothers and a father committed suicide during or after the attack on the child. Looking through the media reports in recent years, you can also find similar tragic cases, and the keywords of these cases often include "postpartum depression", "mental health" and "mother suicide".

Similar cases are not limited to Hong Kong. According to data from Taiwan's Ministry of Health and Welfare from 2017 to the first half of 2021, the total number of people killed by parents or caregivers who "killed their children and committed suicide" was close to 50. In 2018 alone, 33 women were tried for infanticide in Russia, including accountants, teachers, unemployed people, restaurant waiters and more. Russian crime experts say 80 percent of infanticide mothers seek medical attention before their children die, complaining of various conditions such as headaches, insomnia or menstrual disorders. Some tragedies are closely related to "postpartum depression", with a global prevalence of 13% to 19%, and the Hong Kong Centre for Health Protection (CHP) says that about 10% of new mothers will suffer from postpartum depression, but it is believed that some women may not seek medical attention even if they have symptoms, so many cases are not diagnosed, that is, the reality may be much more serious than the relevant statistics.

One difference between "postpartum depression" and other depressions is that suicide caused by the former may be accompanied by infanticide - this is called "extended suicide" and "merciful homicide" in psychology. Some mothers are in a severely depressed state, worried that their children will not be taken care of after they die, and do not want to leave their children alone to suffer in the world, so they simply take their children with them. The question is, why do these mothers think that their children will suffer when they die?

Statistics on cases of mothers suspected of murdering their children from 2020 to date. (Compiled by Hong Kong 01 reporter)

Why aren't new mothers happy?

In 2018, a survey conducted by Procter & Gamble and the Hong Kong Council of Early Childhood Education and Services found that 9% of the mothers surveyed said that they often did not get enough sleep after giving birth, 8% felt increased postpartum pressure, and 2% thought about harming their babies. Mothers often feel more pressured because in the division of labour in the family, whether mothers are employed or not, they are usually assigned the role of caregivers to care for their families, and these caregiving pressures are becoming harmful to children.

In a questionnaire survey conducted by the Carer Platform from 4 April to 27 May this year, 5.5% of the surveyed carers were women, and caregivers devoted an average of 96.89 days a week to caring for children at least 6 hours a day, and 1% said that no one could share the care work. The problem is likely to be exacerbated at the grassroots level. The Hong Kong Council of Social Service conducted a survey on the physical and mental health of mothers of primary children from November 8 to March 52, and found that 2022% of the respondents spent 11 to 2023 hours of independent care for their children on weekdays, and 3% reached 49 to 8 hours, almost all day-on.

In February 2020, in New Taipei City, Taiwan, there was a tragedy of a grassroots single mother: Wu's mother, who was a single parent, was drugged and stunned her sons and daughters, and she also chose to commit suicide but was rescued after being sent to the hospital. In November of the same year, the New Taipei District Court rebuked her for being extremely cold-blooded, vicious, arrogant, egoistic, selfish and ignorant, and sentenced her to death for homicide. The defense lawyer complained about this: The defendant has been raising her child alone for seven years, and the social system has not helped her at all, until she was cornered, the judge did not think that the government and society did not fulfill their responsibility to take care of the child, but coldly accused the defendant of failing to protect the child, and even deprived the child of his life, etc. "The judge is cold-blooded, so why not."

If mothers put too much pressure on themselves, they will increase the possibility of postpartum depression. (gettyimage/Visual China)

Both murderer and victim

In addition to the stress of caring for a newborn baby, neglect by family members can also lead to postpartum depression. After the birth of a child, some families shift their focus from the pregnant woman to the newborn baby, ignoring that the mother who has just given birth is also adjusting to her new role. When these new mothers devote themselves to taking care of their children, they feel that their hard work is neglected by their families, and they are prone to low feelings and anxiety. Many families do not deliberately snub the mother, but the birth of a newborn baby does bring fatigue and stress to the family, and these negative emotions are constantly transmitted within the family, resulting in family members not having time to take care of the mother's needs.

A questionnaire survey conducted by Heep Hong Hong Society, a children's education and rehabilitation organisation and the University of Hong Kong, conducted from February to March 2022 on parental stress and resilience among parents in Hong Kong, showed that more than half of parents experienced depressive symptoms, of which 2% had moderate to severe depressive symptoms. This is not an uncommon finding and the government is not unaware of the crisis of new mothers, but often only calls on parents to focus on mental health; However, mothers are often the primary caregivers of newborn babies and find it difficult to share their stress with other family members, let alone divert their attention through work, socializing, etc.

Forensic psychiatrist Ho Mei Yee in Who is the Victim? He chronicles his experience of treating a mother who killed her underage daughter. The mother's name is Ouyang Yue, her IQ is only 90 points, although she does not want to give birth, she still gives birth to a child, and then the child is taken away and raised by her sister on the grounds that "you don't know how to raise children", and later she was allowed to take care of her daughter with the assistance of her family, while her husband did not care about family affairs. The family once noticed some abnormal behavior of Ouyang Yue: pinching the baby's face, slapping her, pulling the baby to the height of the chest two or three times and throwing it on the bed - all because the baby was crying and was very annoying. However, the family did not pay attention to Ouyang Yue's symptoms, which eventually led to tragedy.

For mothers in subdivided units, the unit area is not large, and when the epidemic suspends classes and schools, they stay at home to take care of their children for a long time without income, and they face great mental pressure. (Profile picture)

What can we do?

He Meiyi judged that Ouyang Yue suffered from postpartum depression, and many symptoms were obvious, she lamented in the book: "Is this society's support for postpartum women not enough? Should we work harder to spread the word about what percentage of women suffer from postpartum depression, and observe that if they have any symptoms, they should see a doctor as soon as possible?" In fact, although the family is not the direct killer of the child, their indifference to the mother, and even the neglect of the family care responsibilities, jointly "caused" this tragedy, as He Meiyi wrote in the book: "I can't understand why her family can't notice her abnormality." If they pay a little attention, the whole thing can actually be avoided." In the above-mentioned survey of grassroots mothers, many respondents reported that partners generally take less than 4 hours to take care of the family.

In the face of our mother's depression, we are not helpless. On the one hand, medical intervention measures can be taken. For example, in the perinatal period before delivery, drastic changes in estrogen and progesterone levels may affect maternal neuroendocrine, neurotransmitter, and biorhythm changes, leading to the onset of depression. Therefore, screening and intervention for depression at this stage helps pregnant women understand that their psychological state needs to be controlled like the body's blood sugar, blood lipids, and blood pressure, and when they have symptoms such as depression after giving birth, they will not be helpless.

Another aspect is to reduce stress on mothers and families through social support. In May 2022, the then Secretary for Labour and Welfare, Law Chi-kwong, in response to a question on emotional support services for pregnant women and their families, pointed out in the Legislative Council that the Labour and Welfare Bureau, the Education Bureau, the Department of Health, the Hospital Authority and the Social Welfare Department jointly implement the measures of comprehensive physical and mental development services for children with a view to early identification of the various health and social needs of children aged 5 to 2017 and their families, and to provide interventional services. From 2019 to <>, each year, the Maternal and Child Health Centres identified <>,<> to <>,<> pregnant women/mothers with emotional problems.

Registered Clinical Psychologist Tang Shiqi listed the depressive symptoms of pregnant women/mothers, pointing out that if a spouse or family member finds that several of these conditions occur in the mother's pregnancy or 2 weeks after giving birth, they should seek professional assistance as soon as possible. (Profile picture)

Don't sanctify motherhood

However, due to the coronavirus pandemic, the number of visits to maternal and child health centres decreased, and this number plummeted to 2020,2021 and 2269,3560 in 2020 and <>. In <>, a research team from a public hospital pointed out that hospitals were temporarily closed for medical visits and accompaniment due to the epidemic, and the lack of the company of relatives in pregnant women led to an upward trend in cases of postpartum depressive symptoms. Therefore, public services should pay attention to the psychological pressures and needs of mothers in different social contexts and provide appropriate support.

In addition, people's perceptions need to change. Many people assume that mothers of newborn babies will naturally immerse themselves in the joy of new life, but do not know that postpartum depression may eat these joys; Many people sing about women's innate motherhood and "motherhood", but they do not know that this is just an imagination that sanctifies motherhood. The mother, mentioned at the beginning of the article and admitted to "infanticide" in the middle of last month, after realizing her emotional problems and the urge to hurt her daughter, tried to search for relevant information and confide in her husband and members of the trauma association, but her husband told her to "relax" and the members of the trauma association asked her to "stay optimistic". The mother's lack of access to help also reflects the lack of social support services, because society is unfamiliar with the needs of postpartum depressed patients, and even if they are as close as a husband, they may not be able to understand the mood of their wives. These patients who want to seek help may need to overcome a greater stigma than other depressed patients because they fear that their depression proves that they are not a "good mother" and are not as happy about the birth of a newborn as a "normal" mother.

At present, postpartum depression screening in Hong Kong mainly relies on the Maternal and Child Health Hospital, which uses the Edinburgh Postpartum Depression Scale (EPDS) to assess mothers at 6 weeks postpartum, which is also a screening scale commonly used in many regions around the world. However, some regions are already reviewing the limitations of the scheme. The Canadian Preventive Care Task Force (CTFPHC) notes that the effectiveness of screening programs is highly uncertain and influenced by many factors, such as paternity, marital stress and the number of births. At the same time, the task force also assessed how pregnant women felt about being screened and found that while they agreed on the importance of screening, they preferred to be concerned about their family situation and mental health rather than undergo a formal medical screening process.

Postnatal depression screening in Hong Kong mainly relies on the Maternal and Child Health Centre, which uses the Edinburgh Postnatal Depression Scale (EPDS) to assess mothers at 6 weeks postpartum. (Taiwan Association for the Prevention and Treatment of Depression)